Inspection on 03/07/08 for Hill House

This inspection was carried out on 3rd July 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Hill House Little Somerford Chippenham Wiltshire SN15 5BH Lead Inspector Alison Duffy Unannounced Inspection 09:50 3rd July 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hill House Address Little Somerford Chippenham Wiltshire SN15 5BH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01666 822363 www.firlawn.co.uk Hill House (Malmesbury) Ltd Mrs Debra Goulding Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 19. This is the first inspection due to the service being new. Date of last inspection Brief Description of the Service: Hill House is registered to provide care for nineteen older people. The home is not registered to provide nursing care, therefore the community nursing team support people with any nursing needs. Mr and Mrs Doveton have recently purchased the home. They also manage a care home with nursing within the local area. The manager is Mrs Anita Keegan. Ms Keegan is not as yet registered with us. The home is a spacious country house located on the outskirts of Malmesbury. Bedrooms consist of one double and seventeen single rooms. Many of these have en-suite facilities. The rooms are located on the ground and first floor. A passenger lift is available to give easier accessibility. There is a library and a spacious dining room with an additional seating area. All areas are individual in style. A large garden is situated to the rear of the property with far reaching open views of the local countryside. Staffing levels are maintained at two carers on duty throughout the waking day. At night there is one waking night staff and a person provides sleeping in provision. Measures are being taken to have two waking night staff. In addition to the care staff, there are domestic staff and a cook. Fees for living at the home, if people are paying privately, range from £541.50 to £575.00. If funded, the fees range from £407.55 to £550.46. The fees are based on the room occupied and the dependency level of the person. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place on the 3rd July 2008 between the hours of 9.50am and 7.30pm. Mr and Mrs Doveton and Ms Keegan were available throughout the inspection and received feedback. The pharmacy inspector visited to look at the medication systems. The findings of this visit are detailed within this report. We met with people who use the service in their own rooms and within communal areas. We met with the staff members on duty. We looked at the management of peoples’ personal monies. We observed the serving of lunch. We looked at care-planning information, training records, staffing rosters and recruitment documentation. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys, to be distributed by the home to peoples’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Ms Keegan an Annual Quality Assurance Assessment (AQAA) to complete. This was returned on time. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: Management have a clear focus about the service they wish to provide. They are committed to developing the service in terms of peoples’ health, safety and general well being. A systematic process of change is being followed. Significant attention has been given to ensuring the safety of the environment. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 6 Systems have been developed and equipment purchased, to minimise the risk of infection. People are encouraged to spend their time as they wish. Visitors are welcomed and important relationships promoted. Meal provision is of a good standard and based on fresh produce and people’s preferences. Fresh fruit is readily available to people. Training is given priority. Staff have covered many topics in a short period of time. Robust recruitment procedures are in place. Systems regarding the safekeeping of people’s personal monies are well managed. What has improved since the last inspection? What they could do better: Staff must ensure that they follow the practice identified within the person’s care plan. This must include regular weight monitoring and moving people safely. All medication must be securely stored. Staff must sign the administration record immediately after ensuring the person has taken the medication administered to them. Risk assessments must be in place for those people wishing to take the responsibility for administering their own medication. The homely remedies policy should be reviewed to ensure it is suitable for the home. A controlled drug cupboard that meets current legislation must be in place. Consideration must be given into ensuring people are happy with the care they receive. Information about people’s care needs should be recorded within the care plan as well as the daily records. Care plans should contain sufficient detail, to ensure staff are fully aware of people’ needs. Any aspect of ill health, identified within the daily records, should include follow up action. Consideration should be given, as to how people with an upstairs room, do not have to go downstairs to have a bath. Consideration should be given to the refurbishment of the laundry. The manager is in the process of registering with us but has not as yet done so. Once all information needed for the assessment process is gathered, the application should be submitted, without delay. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are assessed before admission, enabling an appropriate placement. EVIDENCE: Within the AQAA, under the heading, what we do well, it states ‘operates a quality pre-admission assessment.’ Ms Keegan told us that there had only been one new person to the home, since the new ownership. Ms Keegan had completed an assessment of the person’s needs. We saw that the assessment identified basic care needs. Key headings were used such as washing and dressing, eating and drinking, mobility and socialisation. Ms Keegan told us that all people living in the home had recently been assessed to ensure their needs could be met effectively. Ms Keegan told us that two people had been assessed with high dependency needs. Discussions took place about the future care provision of these people. Peoples’ relatives and the local medical teams were involved. Due to contributory factors, it was Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 10 agreed the people would stay at the home until a time, when their needs could not be met. Hill House does not provide intermediate care, so standard 6 is not applicable to this service. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans generally reflect people’s needs yet staff need to make sure the plans are followed in practice. People have good access to health care provision. The medication arrangements in place should protect people, although better record keeping and safer storage need to be considered. EVIDENCE: People told us that they were generally happy with the care they received. One person said they would like more help both in the morning and the evening. They said they would like to have a bath more often than just once a week. A relative told us ‘It’s not as informal as it used to be. There are lots of new rules and regulations, which everyone has to follow. I mean, no one is allowed in the kitchen anymore so I can’t take my cup back for it to be washed then have a chat with the cook.’ They continued to say ‘maybe it will be for the better in time. The care is excellent, really happy with that. They do everything they can for XX. No complaints about the care, the staff are lovely – it’s just very different.’ Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 12 Within a survey, a relative told us that the home meets the needs of their relative. They said ‘an improvement since the home changed hands.’ They said ‘there has been an improvement in responding to needs, and taking responsibility to sort problems rather than constantly contacting relatives.’ A member of staff told us ‘I feel the needs of all, are carried out to a high standard and individuality of all are essential within Hill House. Carers also have excellent relationships with residents and family members.’ Ms Keegan told us that a new care planning format had been devised. The format contained a summary of people’s needs. Ms Keegan told us the plan was to be used on a short-term basis, as a more detailed format was in the process of being developed. Ms Keegan told us that she working on good record keeping with staff. We saw that some subjective terminology was used. This included ‘was a little confused this evening.’ The care plans we saw were generally clear and well written. We advised greater detail in some areas. For example ‘to be very patient and offer reassurance during any period of confusion’ and ‘to ensure privacy is always maintained’ were stated. There was no evidence as to how these aspects were achieved in practice. There was good detail about the support people needed with their personal care routines. Support with mobility identified the need for good fitting footwear. There were some aspects within daily records, which needed to be recorded within the person’s care plan. This included ‘push fluid – not drinking enough’ and ‘is taking digoxin, pulse must be taken prior to medication. If pulse below 60, omit medication.’ We saw within one daily record ‘fall – hip hurts’ yet there was no follow up action. Within another daily record, it was stated ‘knocked leg. D/N, no bath, keep dry.’ Details of the wound and its management were not stated. There were nutritional, manual handling and tissue viability assessments in place. We saw that those people who were nutritionally at risk, had been referred to the GP and dietician. One plan stated ‘weigh every 2 weeks.’ This had not been done. The plan stated ‘offer high protein diet.’ There was no evidence that this was being undertaken. Ms Keegan told us that new ‘sit on’ weighing scales had been purchased. Ms Keegan told us that a falls assessment was in the process of being introduced. She said that the assistant manager was looking into the occurrence of falls. Contributory factors such as poor fitting footwear were being identified. We saw staff take one person from the dining room to their bedroom in a wheelchair. The wheelchair did not have any footplates. Within the person’s care plan, we saw that the person needed a hoist to support them with all Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 13 transfers. We saw that a member of staff transferred the person from the wheelchair to their armchair, inappropriately without using the hoist. Each person had a record detailing any healthcare intervention. This included the GP, district nurse, chiropodist and optician. We saw that two members of staff completed the administration of the lunchtime medication to people. Only one member of staff however, signed the record, to demonstrate the administration. Our Pharmacist Inspector looked at the arrangements for the handling of medicines. Medicines in current use were stored securely. However there were no suitable arrangements for the storage of medicines, when they were first received from the pharmacy or when any excess supplies were to be returned. The domestic fridge was used for medicines requiring cold storage. A controlled drug cupboard that meets current legislation is required. People have locked cupboards in their rooms to use if they administer their own medication. Printed medication administration records are supplied by the pharmacy. Written additions had been signed and checked. A record of medicines received and returned was kept. The pharmacy is supplying training to all staff who administer medication. The manager monitors staff competency. People are supported to manage their own medicines when they choose to do so, but this practice is not supported by risk assessments and reviews. A list of homely remedies is available to use in the home. The list is not entirely appropriate for the type of home and should be reviewed. There were some gaps on the medication administration record. We found that the medicines had been given but not signed for in a number of cases that day. This could lead to a medicine being given again, as the appropriate record had not been made. Following the inspection, Mrs Doveton told us that a new drugs fridge was on order. An order for a controlled drugs cupboard was also being placed. We saw within the AQAA, that ‘respecting privacy, dignity, diversity and equality’ were aspects the home considers it does well. The AQAA did not describe however, how these aspects were achieved. People told us their privacy and dignity was maintained. They said staff were friendly, respectful and treated them well. Within surveys, under the heading what the home does well, a staff member told us ‘from what I’ve seen so far – communicate and also treat the residents with respect.’ Another member of staff said ‘provide choice at all times. Independence for the service user.’ We saw staff knock on people’s bedroom doors and wait to be asked in before entering. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are content with following their solitary interests yet the planned development of social activity provision would further enhance opportunities for people. People are able to follow their preferred routines and receive visitors as they wish. Meal provision is of a good standard with an emphasis on fresh produce. EVIDENCE: Ms Keegan told us that she is aiming to recruit an activities organiser to work four hours a day. Ms Keegan said that she would like to improve opportunities for social activity provision. Within a survey, a member of staff confirmed this. They said ‘there are plans for more activities and meetings for the residents and I do think it will be a lovely home for them to live in during their final years.’ At present however, many people are content following their solitary interests. People told us that they spent the majority of their time in their room. They said they enjoyed reading, the television and the radio. One person said they liked to sit in the library. Another person told us that ‘the new owners are trying to get things organised.’ They told us about a planned garden party. We saw that croquet was being set up on the lawn, ready for the event. The notice board in the main hallway advertised a guitar ensemble and Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 15 proms on the terrace, with afternoon tea. Ms Keegan told us that there had been a talk on whale and dolphin conservation. There had also been reflexology, a fashion morning and a weekly exercise class. A computer with Internet access was in place. Ms Keegan told us that she was supporting one person to learn new computer skills. We saw that a local village magazine was available in the library, to keep people informed of local community events. Ms Keegan was in the process of gaining wheelchairs for people. Once in place, external activity would be introduced. We saw that garden furniture had been purchased to enable people to sit in the garden. Mrs Doveton told us that some stonework outside had been levelled to enable a safe area. People told us that they could have visitors at anytime. They could entertain in their own room or in the communal areas. One person told us ‘they don’t mind how many people come in and out. My family come quite late after work.’ Another person said ‘I have a friend who spends a lot of time with me here. It’s nice that we can spend time together.’ A relative told us ‘I come whenever I want to. It’s usually at a mealtime, but they are always friendly and we have a chat. They always make you feel welcome and let you know if anything has happened.’ Within a survey, one relative told us that staff are usually good about keeping them informed of matters. They said ‘there has been an improvement recently.’ Ms Keegan told us that two residents meetings have been held. She said she is aiming to encourage people to be more involved in the home and give their views more readily. Ms Keegan told us that she wants to develop more person centred care. People are now given an individual tray with a hot drink, a small teapot, a milk jug and sugar bowl. This is instead of a drinks trolley, whereby staff served the drinks and then distributed them. People told us they were able to follow their preferred routines such as getting up and going to bed. People said they could spend time, independently in their room. One person told us ‘you can have all your meals in your room if you want to, although I generally go down to the dining room at lunchtime. I have my tea in my room. We have a choice of sandwiches or a hot snack, which is nice.’ Another person said ‘they come in early with a cup of tea if you want one. I have that then I might think about getting myself ready for the day. They don’t pressurise you at all and there’s no rush.’ The cook told us that they had recently started employment at the home. They had asked the Environmental Health Officer to visit to ensure the facilities and practices within the kitchen, met current standards of health and safety. While the kitchen would benefit from refurbishment, no requirements were identified. We saw that the cook was very enthusiastic to provide a service that people would enjoy. They told us ‘it’s their home, which they are paying for. If I were staying in a hotel, I would expect good food and good service, so it’s no different.’ Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 16 The cook told us that the menus had been reviewed. There was a high emphasis on fresh produce. There was a bowl of fresh fruit on each dining room table. One person said ‘I suppose I shouldn’t but I take a few pieces, after breakfast, to last me through the day.’ We saw a large selection of vegetables in the refrigerator. The cook was aware of potential eating difficulties. She said some people liked salad although others found it very difficult to eat. The cook told us that the alternative of salad or vegetables was always available. We saw that for lunch the majority of people had lasagne. Some had an omelette. For dessert, people had cherry pie and cream. The cook told us that people generally enjoyed traditional food. She said one person liked Chinese food, so this was accommodated, as an alternative to a main meal. The cook told us she regularly spoke to people about the meals. People were encouraged to give suggestions and say if they liked or disliked what was provided. Mrs Doveton told us that new suppliers had been sought. She said people would only receive quality produce. This included ground coffee and herbal teas. People told us that they enjoyed the meals. One person said ‘we can’t complain, the food is very good.’ Another said ‘it is well cooked and if you don’t like something, they give you an alternative.’ One person told us that they would like to have cake suitable for a diabetic, rather than choosing whether they should eat the ‘ordinary’ homemade cake. Within surveys people told us they liked the meals. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are aware of how to raise any concerns they may have. People are assured greater protection through well-managed adult protection systems. EVIDENCE: People told us that the new owners had changed a number of aspects of the service. One person told us ‘I’ve discussed things with management and things are getting sorted.’ Another person told us that they would speak to the new manager if they were not happy. They said ‘its changed but I’ve not really been affected so far.’ One person told us that they would not want to raise a concern. They said ‘it’s not that people aren’t approachable. It’s just my personality. I wouldn’t want to upset anyone, as that would upset me.’ Mrs Doveton told us that meetings had been arranged with people to talk about matters such as fee increases and proposed changes to the home. She said any concerns raised initially, had been addressed during this time. With surveys, people told us that they knew how to make a complaint. A member of staff told us, in relation to a complaint, ‘in my position I would try to give them some reassurance and ask if they would like me to ask a manager to speak to them.’ A relative told us they knew how to make a complaint. They said ‘sometimes it is not followed through but there has been an improvement recently.’ Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 18 There is a complaint procedure in place. Ms Keegan told us that formats to record, monitor and evaluate complaints were in the process of being developed. The training manager told us that staff had undertaken abuse awareness training. Training in the protection of vulnerable adults was being investigated. Staff told us that they would immediately inform the manager if there were any suspicion or allegation of abuse. Copies of the local reporting procedures ‘No Secrets in Swindon and Wiltshire’ were available. Ms Keegan was clear about these procedures and told us about referring any incident to the local Safeguarding Unit. Following the inspection, an incident was reported appropriately. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the environment to enhance people’s comfort and wellbeing. EVIDENCE: Hill House is a large, spacious country house with far reaching views of the local countryside. Peoples’ bedrooms are located on the ground and first floor. There is a small passenger lift, which gives level access. People have a single room, which they are able to furnish as they wish. People told us that they enjoyed spending time in their rooms. One person said ‘I have everything I need so it’s like home.’ Another person said ‘I love the views and it’s so light and airy in here. It’s big enough to have a table and chairs, so it doesn’t feel like a bedroom.’ One person told us that they had needed to move to an upstairs room. Ms Keegan explained the reason for this. They wondered why they needed to go downstairs for a bath. Ms Keegan told Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 20 us that there was an assisted bath downstairs. She said the upstairs bathroom contained wooden flooring, which would not support a manual hoist. We recommended that ways of enabling people to bathe upstairs, be investigated. Mrs Doveton told us that since taking over the ownership of the home, six bedrooms have been redecorated. The stairs have been re-carpeted. Further refurbishment of each room is planned. There are plans to develop a hairdressing room. A new call bell system has been installed. Ms Keegan told us that there are plans to install a loop system within two bedrooms and the communal areas, to assist with peoples’ hearing loss. Within the AQAA, it stated that over the next 12 months, the lighting in the downstairs hallway was to be improved. All areas were cleaned to a good standard. There were no unpleasant odours. Clinical waste bins had been introduced as part of a contract. All hand washbasins in communal bathrooms and toilets contain paper towels and pump action soap dispensers. Ms Keegan told us that she was planning to introduce these facilities within people’s en-suite facilities. We saw that there was antibacterial hand gel in the entrance hall for visitors to use. Ms Keegan told us that a new washing machine had been purchased. New equipment such as colour coordinated mops and buckets, for specific areas of the home, were in place. The laundry had been tidied. All hazardous materials were securely stored. The laundry was difficult to keep clean and in need of refurbishment. Mrs Doveton told us that a new commercial laundry and kitchen are planned. People told us the laundry service was satisfactory. One person said they would like staff to put their laundry away, rather than leaving it on their bed. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels have been increased to accommodate peoples’ needs. People are protected through a clear, well-managed recruitment procedure. Staff training is given priority, enabling staff to increase their knowledge and develop service provision. EVIDENCE: There are two care staff on duty during the waking day. The assistant manager works in a supervisory role but also works, as part of the working roster. When on duty, she works with people, as a third member of staff. At night, there is one member of waking staff and another provides sleeping in provision. Ms Keegan told us that she intends to increase staffing levels by employing another waking night staff. Some staff have been recruited into this position. There are three, sometimes four nights, when there are two waking night staff on duty. Ms Keegan told us that a number of staff had left the home, due to the home’s change of ownership. In response to this, there has been a strong recruitment drive. More care staff, a domestic and a second cook are still required. Ms Keegan told us that until the positions are filled, existing staff are covering additional shifts. Some agency staff are also being used. One member of staff told us there were enough staff to meet people’s needs. They said ‘yes [there are enough staff] but the home is going through a very big change with new ownership. The staff numbers are being increased but Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 22 each of the 3 shifts has 2 staff.’ Another staff member said ‘there have been lots of changes. It’s been difficult to get used to but it’s going ok. We’re getting there.’ People were complimentary about the staff. One person said ‘they are all really good.’ Another said ‘they are all very helpful. They can’t do enough for us.’ With surveys, staff told us that they had been through a robust recruitment procedure. One member of staff said ‘and they chased up a late reference.’ We looked at the recruitment documentation of three most recently employed members of staff. All files contained the required information. All prospective staff had been checked against the Protection of Vulnerable Adults register before commencing employment. This assured their suitability to work with vulnerable people. There was evidence of each person’s interview. Topics such as abuse and privacy and dignity had been addressed. Within surveys, people told us they received training in relation to their role. Ms Keegan told us that at present, only two of the staff have National Vocational Qualification level 2. Ten places have been booked for staff to complete this training later in the year. Ms Keegan told us that significant attention has been given to staff training. There is a training manger who coordinates, arranges and facilitates training sessions for staff. The training manager told us that a training session is arranged on a fortnightly basis. So far, there has been training on dementia care, hearing and vision awareness, infection control, pressure area care, moving and handling, food and nutrition and first aid. A training session on health and safety was completed during the inspection. There was good attendance and staff were animated and involved in the session. Within surveys, people told us that staff listen and act on what they say. One person said ‘the girls could not be nicer.’ People said the staff were available when needed. One person said ‘staff are always helpful.’ As a means to improve the service, a relative told us ‘communication between staff and from one shift to another. Otherwise relatives are constantly having to repeat themselves.’ Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are benefiting from new ownership, clear leadership and the introduction of new systems. The safe keeping of peoples’ personal monies is well managed therefore minimising the risk of financial abuse. Peoples’ wellbeing is promoted through clear health and safety systems. EVIDENCE: Ms Keegan commenced her position at the beginning of May 2008. She told us she was in the process of completing her application to become registered with us. Ms Keegan previously worked in the other care home within the organisation. She is a Registered Nurse and has just registered to start the Registered Managers Award. Ms Keegan told us that she has spent time building relationships with people who use the service, their families and staff. She has introduced new systems, purchased new equipment and has targeted Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 24 areas such as health and safety. Ms Keegan told us she has an open door policy. She aims to involve people in discussions about the proposed developments of the home. Ms Keegan told us that her time in post has been a challenge for all concerned due to the upheaval of new ownership. One member of staff within their survey said ‘my manager makes herself available for any problems or plans which I need to discuss.’ Another said ‘there have been 2 or 3 staff meetings since the new owners arrived. I attended the last one and heard staff say that it was really nice to be able to air their views.’ Within surveys, there were various comments about the change in ownership. These included ‘since the new care manager has been appointed, improvements are very much noticeable and long may that continue’ and ‘since working at Hill House there are many changes taking place, all of those are beneficial to the House. Over a period of time I believe that the house will achieve a lovely home for the new service users.’ Ms Keegan told us that the home would be adopting the organisation’s quality auditing system. This will involve various audits. There will be questionnaires to gain feedback from people, their families and involved health care professionals. Ms Keegan told us that she felt it was too early to start the quality assurance processes. In the meantime, staff and residents meetings had been introduced. Ms Keegan said in time, when relationships had been developed further, questionnaires would be forwarded to people. A system to enable people to place small amounts of their personal monies for the home to hold safely has been introduced. The records to demonstrate all transactions were clear. Two members of staff had signed all transactions and receipts were in place. Cash amounts corresponded with the balance sheets. Ms Keegan told us that there was restricted access to the system, to minimise the risk of any financial abuse. A number of aspects have been developed to ensure people’s safety. There have been new fire extinguishers, brake glass points to activate the fire alarm system and emergency lighting. The fire zones are clearly displayed to enable staff clear information in the event of needing to locate a fire. A number of fire extinguishers have been purchased for staff training purposes. Door guards to enable some people to hold their bedroom doors open safely have been installed. Ms Keegan told us that the Fire and Rescue Service has given authorisation that the gate to the back stairs is safe. Mrs Doveton told us that the heating and hot water systems have been fully serviced with necessary works completed. Heated towel rails in the bathroom have been regulated to an appropriate temperature. The hot water is monitored on a daily basis. Ms Keegan told us that if the temperatures become unpredictable, regulators would be fitted, to ensure a safe temperature. Staff have completed health and safety training. Risk assessments are being developed. In response to the perceived risks identified with the stair lift, it has been removed. There is restricted staff access to the kitchen. Anyone needing to enter must wear a Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 25 white overall. A record of the temperatures of the refrigerator, freezer and all hot food is maintained. The cook told us that they had requested the Environmental Health Officer to visit to ensure the systems and facilities within the kitchen were safe. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP7 Regulation 13(5) 15 Requirement Staff must ensure that they move people safely, as stated in the care plan. Care provision should be reviewed to ensure people are happy with the care practices currently in place. Care practices identified within people’s care plans must be applied in practice. This must include monitoring people’s weight if a risk of poor nutritional intake is identified. Suitable secure storage must be in place for all medicines held in the home. All controlled drugs must be stored in a cupboard which meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007.) All self-medication must be subject to a robust risk assessment, which is regularly reviewed. All appropriate entries on the medication administration record DS0000070482.V365485.R02.S.doc Timescale for action 03/07/08 03/07/08 3 OP8 12(1)(a) 03/07/08 4 5 OP9 OP9 13(2) 13(2) 18/08/08 01/11/08 6 OP9 13(2) 01/09/08 7 OP9 13(2) 18/08/08 Hill House Version 5.2 Page 28 must be made at the time of administration to ensure that there is no confusion as to what medicines have been given. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 Refer to Standard OP7 OP7 OP7 OP8 OP9 OP9 OP15 OP19 Good Practice Recommendations Care plans should contain sufficient detail, to ensure staff are fully aware of people’ needs. Staff should ensure that they record factual information within peoples’ daily records rather than subjective terminology. Information about people’s care provision should be included within the person’s care plan, as well as their daily records. When moving a person in a wheelchair, foot plates should be in place. The list of homely medicines should be reviewed to make sure it is suitable for home. The manager should regularly audit the medication administration records to check that they are completed correctly and take any appropriate actions. People with diabetes should have food such as homemade cake, related to their need. Consideration should be given to installing an assisted bath or shower on the first floor. Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hill House DS0000070482.V365485.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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